促泌剂对胰岛素强化治疗后的初诊2型糖尿病患者胰岛β细胞分泌胰岛素的影响

Effects of insulin secretagogeus on insulin secretion of islet β-cell in newly diagnosed type 2 diabetic patients with short-term insulin intensive therapy

目的:观察瑞格列奈或格列美脲对短期胰岛素强化治疗后血糖达标的初诊2型糖尿病(T2DM)患者胰岛β细胞分泌胰岛素的影响。方法:对60例经为期约2周的胰岛素强化治疗后血糖达标的初诊T2DM患者,进行75 g葡萄糖耐量试验(OGTT),测定血糖和胰岛素值,计算早相胰岛β细胞分泌指数(△I30/△G30,糖负荷30 min净增胰岛素与净增葡萄糖的比值),以30～120 min的胰岛素分泌曲线下面积和葡萄糖曲线下面积比值(△AUCI 30-120/△AUCG 30-120)表示晚相胰岛素分泌能力。然后按照1∶1比例,随机分成瑞格列奈组和格列美脲组,分别接受瑞格列奈和格列美脲治疗,维持6个月后重复行OGTT,检测上述指标。对口服药物治疗前后胰岛β细胞功能进行自身比较。结果:瑞格列奈组△I30/△G30差异有显著性(P<0.01),而△AUCI 30-120/△AUCG 30-120无统计学意义(P>0.05)。格列美脲组△AUCI 30-120/△AUCG 30-120显著上升(P<0.05),而△I30/△G30无统计学意义(P>0.05)。结论:瑞格列奈以促进早相分泌为主,格列美脲以促进晚相分泌为主。

Objective：To investigate the effects of repaglinide and glimepiride on insulin secretion of islet β-cell in newly diagnosed type 2 diabetic（T2DM）patients who had accepted short-term insulin intensive therapy.Methods：Sixty newly-diagnosed T2DM patients who had accepted insulin intensive therapy for about 2 weeks and achieved optimal glycemic control,were given 75 g of glucose.Levels of glucose and insulin during oral glucose tolerance test（OGTT） were examined.Early-phase insulin secretion index（△I30/△G30）,the radio of the increment of insulin to that of plasma glucose at 30 min after the glucose load,was used to assess the early phase insulin secretion.The radio of insulin area under curve to that of glucose area under curve between 30～120 min（△AUCI 30-120/△AUCG 30-120） was used to assess the late phase insulin secretion.Then they were randomly divided into two groups and treated with repaglinide and glimepiride for 6 months.OGTT were then repeated and indexes above were measured after 6 months in each group.Results：△I30/△G30 were increased significantly（P0.01）,while no difference was noted in △AUCI 30-120/△AUCG30-120（P0.05）in repaglinide group.△AUCI 30-120/△AUCG 30-120 were increased significantly（P0.05）,but no difference was noted in △I30/△G30 in glimepiride group.Conclusion：Repaglinide mainly enhances the early phase insulin secretion.Glimepiride mainly enhances the late phase insulin secretion.